Reproductive health advice can be confusing – we tackle some of your most pressing questions…
Periods. Perimenopause. PCOS; Trying to get to the root of your reproductive health can sometimes be painful and problematic to go through – and to talk about. But the experts agree it’s worth getting to know yourself a little better.
Talking about taboo subjects keeps them in the open – and it’s good to know about all the different variations of ‘normal’. By ignoring problems, things can get often worse or lead to damage or more serious problems.
“It’s something we should talk about because it helps us address various changes and health issues a woman faces as she gets older,” says Raef Faris, gynaecology and fertility consultant at The Lister Hospital (hcahealthcare.co.uk). “Reproductive and hormone health can also give us an early indicator of other issues related to general health before they occur – and can affect not only the current generation, but the next one as well.”
Here, our experts give their advice on some of your most pressing hormonal health issues…
How old are you when you enter perimenopause?
It’s easy to get the menopause and perimenopause muddled. Many women believe menopause begins with a period of symptoms, such as hot flushes and finishes with menstruation ending.
“In fact, by definition, the menopause is when the menstrual cycle has ended completely. The period of symptoms experienced while still menstruating, which can be very different for each woman, is the perimenopause,” says Faris.
“Menopause generally occurs between 42 and 54 years old. Perimenopause is hard to define, because it varies so much from woman to woman – but can last anywhere from one to three years with any combination of symptoms. The symptoms might include hot flushes, irregular periods, breast tenderness, decreased libido and fatigue, as well as mood swings and trouble sleeping. Perimenopause can be indicated by reduced ovarian reserves shown by hormone tests, but this isn’t in itself a symptom.”
I’m suffering from social anxiety and agoraphobia during the menopause – is this normal?
“Sometimes we do not have enough of one hormone and too much of another and the close relationship between hormones and our brain chemicals, also known as neurotransmitters, can have a profound impact on our psychological wellbeing,” says nutritional therapist Henrietta Norton (wildnutrition.com).
“A combination of aerobic and restorative exercise once a week has been shown to reduce symptoms and support a healthy weight. Stress can also have a significant influence on experience of the menopause so set aside regular time to do something that makes you feel good.
“Be mindful of environmental oestrogens that may act as harmful hormone disruptors – don’t cook or heat foods in plastic, for example, and ensure you’re getting enough magnesium. It helps support the nervous and cardiac system, and healthy bones, as well as reducing the symptoms of imbalance such as anxiety, sugar cravings and sleep disorders.
“Extreme anxiety or agoraphobia are conditions in their own right, however, and although they may be exaggerated by the changes experienced during the menopause, I would recommend seeking support from a psychologist to deepen your understanding of the root of these feelings.”
I’m 39 and trying for a baby – is there anything I can do to increase my chances of conceiving?
“There is a myth that female fertility drops abruptly after the age of 35, but the reality is that fertility gradually decreases from the age of 30,” says Farris. “A woman’s fertility levels will be gradually lower at 31 than 30, and a little lower the year after that, until they reach the menopause. At 39, it’s worth considering provisional hormone tests to determine your ovarian reserve, an ultrasound scan, and a sperm analysis for your partner.”
While conceiving as you get older can be harder, it is not impossible – and there are some things you can try to give nature a boost. Experts advise against timing too obsessively, but instead having regular intercourse every two or three days between the end of your period and day 20 of your cycle.
“Be mindful of changes in your body and start to track your cycle so you know when you are most fertile,” says Dr Geetha Venkat, director of the Harley Street Fertility Clinic (hsfc.org.uk). “Eat a healthy diet and take folic acid and a prenatal vitamin supplement. Give up alcohol and stop smoking. Avoid high-impact exercise, but do light workouts as keeping your stress levels down is very important.”
When do I need to go for a cervical screening?
Women in the UK need to get a cervical screening test every three years from the age of 25 to 49. After that, it’s still important to continue cervical screenings every five years until the age of 60.
“I cannot stress how important regular cervical screening is,” says Dr Venkat. “Cervical screening (aka a smear test) checks the health of your cervix – the opening to the womb from the vagina – and while it doesn’t test for cancer, it’s a test to help prevent cancer. It can be a matter of life and death, so cannot be ignored.”
I’ve started getting hair around my chin and jawline – could this be a hormonal imbalance?
“Hair around the chin and jawline could be related to the reproduction hormone itself or related to changes in hormones from elsewhere in the body,” says Faris. “The most common cause of hair growth on the jawline and chin in women is Polycystic Ovarian Syndrome (PCOS), so it’s important to see your GP or gynaecologist to get the relevant hormone tests, and ultrasound scan.”
Will losing weight have an effect on PCOS?
PCOS is one of the most common hormonal disorders for women and can lead to excess hair, acne and breakouts, irregular or absent periods as well as weight gain and depression. It is related to hormone levels and insulin production but can be managed and improved through diet and exercise.
“Adipose tissue or fat cells have the ability to generate their own production of hormones, affecting the fine balance between oestrogen and testosterone. Because these hormones can be in excess in cases of PCOS, achieving a healthy weight can help to readdress hormone imbalances,” says Norton. “Support glucose regulation with a diet low in grains and highglycaemic foods, such as refined sugar and trans fats. There is evidence to suggest the health of the digestive system and a sub-functioning or hyper-functioning thyroid can also influence the development and progression of PCOS.
“Regularly exercising in nature, in a way that suits you and your lifestyle, will improve your body’s production of sex hormone binding globulin (SHBG) which helps to regulate oestrogen and testosterone, as well as supporting mood, stress and balancing weight.”